| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,081 |
1,145 |
$655K |
| D7240 |
Removal of impacted tooth - completely bony |
317 |
130 |
$66K |
| D7230 |
|
380 |
193 |
$64K |
| D7310 |
|
1,027 |
305 |
$31K |
| D0330 |
Panoramic radiographic image |
624 |
623 |
$24K |
| D7220 |
|
68 |
43 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
12 |
12 |
$3K |
| D9222 |
|
12 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$1K |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$1K |
| D1206 |
Topical application of fluoride varnish |
70 |
70 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
61 |
61 |
$1K |
| D1330 |
|
77 |
77 |
$895.03 |
| D1310 |
|
78 |
78 |
$892.13 |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$887.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
68 |
$774.17 |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
75 |
$569.22 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$546.20 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$243.60 |
| D1999 |
|
13 |
12 |
$94.00 |